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2.
Urology ; 156: 289-295, 2021 10.
Article in English | MEDLINE | ID: covidwho-1246218

ABSTRACT

OBJECTIVE: To evaluate the urology providers' (through a range of training levels) experience utilizing telemedicine given the rapid nationwide implementation of telemedicine in urology practices due to COVID-19. Several studies focusing on the patient's perspective have illustrated that telemedicine is comparable to traditional office visits in terms of cost, communication, and overall satisfaction. However, there is sparse data on the provider's experience. METHODS: With IRB approval, we assessed provider satisfaction with telemedicine at Urology programs in the U.S. through an electronic survey. The 25-question survey was based on the Patient Assessment of Communication of Telehealth which is a validated 33 question instrument that has been utilized to assess the quality of patient-provider communication in telemedicine. Experience with telemedicine was assessed in 2 categories: technical aspects and communication with patients. Variables were rated using a 5-point Likert Scale. RESULTS: There were 144 responses to the survey. 50% of providers reported not receiving any formal training in using telemedicine. This differed significantly by training level with 55% of attendings having had received training vs 20% of residents. Providers felt they would most benefit from training in billing (52%) rather than equipment use (33%) or communication (28%). 87% of providers felt comfortable discussing sensitive topics while only 55% felt comfortable using telehealth to schedule surgery (P < .001). CONCLUSION: Urology providers are generally satisfied with their experience communicating with patients via telemedicine and the majority would opt to continue utilizing telemedicine. Nevertheless, many providers are hesitant to schedule surgery via telemedicine. Providers would benefit from formal training in telemedicine.


Subject(s)
Attitude of Health Personnel , COVID-19/prevention & control , Telemedicine , Urologists/education , Urology , Adult , Appointments and Schedules , Communication , Female , Humans , Internship and Residency/statistics & numerical data , Male , Middle Aged , Physician-Patient Relations , SARS-CoV-2 , Software , Surveys and Questionnaires , Urologic Surgical Procedures , Urologists/statistics & numerical data , Urology/organization & administration
4.
Urologia ; 88(1): 3-8, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1105635

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic has dramatically hit all Europe and Northern Italy in particular. The reallocation of medical resources has caused a sharp reduction in the activity of many medical disciplines, including urology. The restricted availability of resources is expected to cause a delay in the treatment of urological cancers and to negatively influence the clinical history of many cancer patients. In this study, we describe COVID-19 impact on uro-oncological management in Piedmont/Valle d'Aosta, estimating its future impact. METHODS: We performed an online survey in 12 urological centers, belonging to the Oncological Network of Piedmont/Valle d'Aosta, to estimate the impact of COVID-19 emergency on their practice. On this basis, we then estimated the medical working capacity needed to absorb all postponed uro-oncological procedures. RESULTS: Most centers (77%) declared to be "much"/"very much" affected by COVID-19 emergency. If uro-oncological consultations for newly diagnosed cancers were often maintained, follow-up consultations were more than halved or even suspended in around two out of three centers. In-office and day-hospital procedures were generally only mildly reduced, whereas major uro-oncological procedures were more than halved or even suspended in 60% of centers. To clear waiting list backlog, the urological working capacity should dramatically increase in the next months; delays greater than 1 month are expected for more than 50% of uro-oncological procedures. CONCLUSIONS: COVID-19 emergency has dramatically slowed down uro-oncological activity in Piedmont and Valle d'Aosta. Ideally, uro-oncological patients should be referred to COVID-19-free tertiary urological centers to ensure a timely management.


Subject(s)
COVID-19/epidemiology , Continuity of Patient Care , Health Services Accessibility , Medical Oncology/statistics & numerical data , Pandemics , SARS-CoV-2 , Urologic Surgical Procedures/statistics & numerical data , Urology/statistics & numerical data , Appointments and Schedules , Female , Health Care Surveys , Humans , Italy/epidemiology , Kidney Neoplasms/epidemiology , Kidney Neoplasms/surgery , Male , Medical Oncology/organization & administration , Procedures and Techniques Utilization , Prostatic Neoplasms/epidemiology , Prostatic Neoplasms/surgery , Urinary Bladder Neoplasms/epidemiology , Urinary Bladder Neoplasms/surgery , Urologic Neoplasms/epidemiology , Urologic Neoplasms/surgery , Urology/organization & administration
5.
Clin Genitourin Cancer ; 19(3): e178-e183, 2021 06.
Article in English | MEDLINE | ID: covidwho-1014409

ABSTRACT

BACKGROUND: The worldwide Coronavirus disease 2019 (COVID-19) public health pandemic has restructured clinical care of patients with cancer throughout the world. The specific changes in the management of genitourinary (GU) cancers in different cancer centers owing to COVID-19 are not known, and some clinical scenarios remain controversial. We conducted an opinion survey to determine what changes in cancer treatment strategies are occurring owing to the COVID-19 pandemic. MATERIALS AND METHODS: A 20-item online survey was sent on May 25, 2020 to 170 expert GU medical oncologists from Europe and North America. The survey solicited responses to changes in GU cancer management in the setting of the COVID-19 pandemic. Data was collected and managed via a secure REDCap Database. RESULTS: Surveys were completed by 78 (45.8%) of 170 GU oncologists between May 25, 2020 and June 25, 2020. Clinical practice changes owing to COVID-19 in at least one scenario were reported by 79.1% of responders, most pronounced in prostate cancer (71.8%) and least pronounced in urothelial cancer (23%). Preferences for change in management varied by country, with 78% (37/47) of United States oncologists indicating a change in their practice, 57% (4/7) of Canadian oncologists, and 79% (19/24) of European oncologists. CONCLUSIONS: This study suggests international practice changes are occurring in GU cancer care during the COVID-19 pandemic. The variability in practice changes between countries may reflect differences in COVID-19 case load during the time point of data collection. These results, based on expert opinion during this rapidly changing crisis, may inform the oncologic community regarding the effects of COVID-19 on GU cancer care.


Subject(s)
COVID-19/prevention & control , Medical Oncology/methods , Telemedicine , Urogenital Neoplasms , COVID-19/epidemiology , COVID-19/psychology , Expert Testimony , Humans , Internet , Medical Oncology/trends , Pandemics , Public Health , SARS-CoV-2 , Surveys and Questionnaires , Urogenital Neoplasms/diagnosis , Urogenital Neoplasms/therapy , Urology/organization & administration
6.
Urol J ; 17(6): 677-679, 2020 Nov 04.
Article in English | MEDLINE | ID: covidwho-914927

ABSTRACT

PURPOSE: This study aimed to investigate the impact of COVID-19 on urology practice in Indonesia. MATERIAL AND METHODS: This was a cross-sectional study using web-based questionnaire (Survey Monkey), which was distributed and collected within a period of three weeks. All practicing urologists in Indonesia were sent an e-questionnaire link via E-mail, WhatsApp Messenger application, and/or short message service, and the chief of residents in each urology centre distributed the e-questionnaire to urology residents. RESULTS: The response rate was 369/485 (76%) among urologists and 220/220 (100%) among urology residents. Less than 10 percent of the responses in each section were incomplete. There are 35/369 (9.5%) of urologists and 59/220 (26.8%) of urology residents had been suspected as COVID-19 patients, of whom seven of them were confirmed to be COVID-19 positive. The majority of urologists (66%) preferred to continue face-to-face consultations with a limited number of patients, and more than 60% of urologists preferred to postpone the majority (66%) or all elective surgery. Most urologists also chose to postpone elective surgery in patient with COVID-19-related symptoms and patient who required post-operative ICU-care. Urologist and urology residents reported high rates of using personal protective equipment, except for medical gowns and N95 masks, which were in short supply. Several uro-oncology surgeries were considered to be the top priority for Indonesian urologist during COVID-19 epidemic period. CONCLUSION: The COVID-19 pandemic has caused a decline in urology service in both outpatient clinic and surgery services with uro-oncological procedure as a priority to conduct.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Personal Protective Equipment/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Urology/statistics & numerical data , Adult , Aged , COVID-19/diagnosis , Elective Surgical Procedures/statistics & numerical data , Hospitals, Private/statistics & numerical data , Hospitals, Public/statistics & numerical data , Humans , Indonesia/epidemiology , Internship and Residency/statistics & numerical data , Laparoscopy/statistics & numerical data , Middle Aged , Personal Protective Equipment/supply & distribution , Personnel Staffing and Scheduling , SARS-CoV-2 , Surveys and Questionnaires , Telemedicine/statistics & numerical data , Urologists/statistics & numerical data , Urology/education , Urology/organization & administration , Young Adult
7.
Urology ; 147: 14-20, 2021 01.
Article in English | MEDLINE | ID: covidwho-880619

ABSTRACT

OBJECTIVE: To assess the effectiveness of a telemedicine service for ureteric colic patients in reducing the number of unnecessary face-to-face consultations and shortening waiting time for appointments. METHODS: A telemedicine workflow was implemented as a quality improvement study using the Plan-Do-Study-Act method. All patients presenting with ureteric colic without high-risk features of fever, severe pain, and hydronephrosis, were recruited, and face-to-face appointments to review scan results were replaced with phone consultations. Data were prospectively collected over 3 years (January 2017 to December 2019). Patient outcomes including the reduction in face-to-face review visits, time to review, reattendance and intervention rates, were tracked in an interrupted time-series analysis, and qualitative feedback was obtained from patients and clinicians. RESULTS: Around 53.2% of patients presenting with ureteric colic were recruited into the telemedicine workflow. A total of 465 patients (46.2%) had normal scan results and 250 patients (24.9%) did not attend their scan appointments, hence reducing the number of face-to-face consultations by 71.1%. A total of 230 patients (22.9%) required subsequent follow-up with urology, while 61 patients (6.1%) were referred to other specialties. Mean (SD) time to review was 30.0 (6.2) days, 6-month intervention rate was 3.4% (n = 34) and unplanned reattendance rate was 3.2% (n = 32). Around 93.1% of patients reported satisfaction with the service. CONCLUSION: The ureteric colic telemedicine service successfully and sustainably reduced the number of face-to-face consultations and time to review without compromising on patient safety. The availability of this telemedicine service has become even more important in helping us provide care to patients with ureteric colic in the current COVID-19 pandemic.


Subject(s)
Quality Improvement , Remote Consultation/organization & administration , Renal Colic/diagnosis , Ureteral Calculi/diagnosis , Urology/organization & administration , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Female , Health Plan Implementation/organization & administration , Humans , Infection Control/organization & administration , Infection Control/standards , Male , Middle Aged , Pandemics/prevention & control , Patient Safety/standards , Patient Satisfaction , Pilot Projects , Prospective Studies , Qualitative Research , Remote Consultation/standards , Renal Colic/etiology , Renal Colic/therapy , Singapore/epidemiology , Telephone , Tertiary Care Centers/organization & administration , Tertiary Care Centers/standards , Tomography, X-Ray Computed , Ureter/diagnostic imaging , Ureteral Calculi/complications , Ureteral Calculi/therapy , Urology/methods , Urology/standards
8.
J Pediatr Urol ; 16(6): 840.e1-840.e6, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-836942

ABSTRACT

INTRODUCTION: Telemedicine video visits are an under-utilized form of delivering health care. However due to the COVID-19 pandemic, practices are rapidly adapting telemedicine for patient care. We describe our experience in rapidly introducing video visits in a tertiary academic pediatric urology practice, serving primarily rural patients during the COVID-19 pandemic. OBJECTIVE: The primary aim of this study was to assess visit success rate and identify barriers to completing video visits. The secondary aim identified types of pathologies feasible for video visits and travel time saved. We hypothesize socioeconomic status is a predictor of a successful visit. MATERIALS AND METHODS: Data was prospectively collected and analyzed on video visits focusing on visit success, defined by satisfactory completion of the visit as assessed by the provider. Other variables collected included duration, video platform and technical problems. Retrospective data was collected via chart review and analyzed including demographics, insurance, and distance to care. Socioeconomic status was estimated using the Distressed Communities Index generated for patient zip code. RESULTS/DISCUSSION: Out of 116 attempted visits, 81% were successful. The top two reasons for failure were "no-show" (64%) and inability to connect (14%). Success versus failure of visit was similar for patient age (p = 0.23), sex (p = 0.42), type of visit (initial vs. established) (p = 0.51), and socioeconomic status (p = 0.39). After adjusting for race, socioeconomic status, and type of provider, having public insurance remained a significant predictor of failure (p = 0.017). Successful visits were conducted on multiple common pediatric urologic problems (excluding visits requiring palpation on exam), and video was sufficient for physical exams in most cases (Summary Table). A median of 2.25 h of travel time was saved. CONCLUSIONS: While socioeconomic status, estimated using the Distressed Communities Index, did not predict success of video visits, patients with public insurance were more likely to have a failed video visit. There is compelling evidence that effective video visits for certain pathologies can be rapidly achieved in a pediatric urology practice with minimal preparation time.


Subject(s)
COVID-19/epidemiology , Pandemics , SARS-CoV-2 , Telemedicine/organization & administration , Urologic Diseases/epidemiology , Urology/organization & administration , Child , Child, Preschool , Comorbidity , Female , Follow-Up Studies , Humans , Infant , Male , Prospective Studies , Rural Population , Socioeconomic Factors , United States/epidemiology , Urologic Diseases/therapy , Video Recording
9.
Actas Urol Esp (Engl Ed) ; 44(10): 644-652, 2020 Dec.
Article in English, Spanish | MEDLINE | ID: covidwho-834165

ABSTRACT

INTRODUCTION: Telemedicine provides remote clinical support through technology tools. It can facilitate medical care delivery while reducing unnecessary office visits. The COVID-19 outbreak has caused an abrupt change in our daily urological practice, where teleconsultations play a crucial role. OBJECTIVE: To provide practical recommendations for the effective use of technological tools in telemedicine. MATERIALS AND METHODS: A literature search was conducted on Medline until April 2020. We selected the most relevant articles related to «telemedicine¼ and «smart working¼ that could provide valuable information. RESULTS: Telemedicine refers to the use of electronic information and telecommunication tools to provide remote clinical health care support. Smart working is a working approach that uses new or existing technologies to improve performance. Telemedicine is becoming a useful and fundamental tool during the COVID-19 pandemic and will be even more in the future. It is time for us to officially give telemedicine the place it deserves in clinical practice, and it is our responsibility to adapt and familiarize with all the tools and possible strategies for its optimal implementation. We must guarantee that the quality of care received by patients and perceived by them and their families is of the highest standard. CONCLUSIONS: Telemedicine facilitates remote specialized urological clinical support and solves problems caused by limited patient mobility or transfer, reduces unnecessary visits to clinics and is useful to reduce the risk of COVID-19 viral transmission.


Subject(s)
COVID-19/epidemiology , Pandemics , SARS-CoV-2 , Telemedicine , Urology/methods , Air Pollution/prevention & control , Appointments and Schedules , Confidentiality , Diagnostic Techniques, Urological , Electronic Health Records , Europe/epidemiology , Humans , Informed Consent , Practice Guidelines as Topic , Quality of Health Care , Societies, Medical , Telemedicine/organization & administration , Telemedicine/standards , Triage/methods , Urology/organization & administration , Urology/standards
10.
Actas Urol Esp (Engl Ed) ; 44(9): 597-603, 2020 Nov.
Article in English, Spanish | MEDLINE | ID: covidwho-778298

ABSTRACT

OBJECTIVE: Design a care protocol to restart scheduled surgical activity in a Urology service of a third level hospital in the Community of Madrid, in a safe way for our patients and professionals in the context of the SARS-CoV-2 coronavirus epidemic. MATERIAL AND METHODS: A multidisciplinary group reviewed the different recommendations of the literature, national and international health organizations and scientific societies, as well as their application to our environment. Once scheduled surgery has restarted, the patients undergoing surgery for complications related to COVID-19 are being followed up. RESULTS: Since the resumption of surgical activity, 19 patients have been scheduled, of which 2 have been suspended for presenting COVID-19, one diagnosed by positive PCR for SARS-CoV-2, and another by laboratory and imaging findings compatible with this infection. With a median follow-up of 10 days (4-14 days), no complications related to COVID-19 were detected. CONCLUSIONS: Preliminary results indicate that the protocol designed to ensure the correct application of preventive measures against the transmission of coronavirus infection is being safe and effective.


Subject(s)
Betacoronavirus , Consensus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Urologic Surgical Procedures/statistics & numerical data , Urology/organization & administration , Adult , Aged , Aged, 80 and over , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/statistics & numerical data , Clinical Protocols , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Female , Follow-Up Studies , Hospitals, University , Humans , Male , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Polymerase Chain Reaction , Prospective Studies , SARS-CoV-2 , Spain/epidemiology , Tertiary Care Centers , Time Factors , Urologic Neoplasms/surgery
11.
Urol J ; 17(5): 536-539, 2020 Aug 09.
Article in English | MEDLINE | ID: covidwho-738680

ABSTRACT

COVID-19 pandemic has affected more than a million people worldwide causing a public health crisis. Under these unique circumstances, urologists continue to provide essential healthcare services and support healthcare systems, by participating in the treatment of COVID-19(+) patients and sparing vital equipment and hospital beds. However, delivering medical care during the pandemic requires strategic planning for all surgical and outpatient activities. Proposed measures include rescheduling elective non-oncological surgeries and using a prioritization protocol for oncological surgeries according to hospital capacity. Following that, outpatient clinics could be partly replaced by telemedicine. Additionally, urologists should be trained in screening and treating patients with COVID-19 during their daily routine.  In order to efficiently provide their services, a management protocol for suspected or known COVID-19 urological patients should be implemented. Furthermore, preventive measures for the nosocomial dispersion of the virus and training on self-protective equipment is mandatory for all physicians. Finally, organizational planning for the best utilization of the staff is of utmost importance. Implementation and adaptation of the protocols according to local requirements and guidelines will ameliorate the quality of services and population's health status. Finally, enhancement of current practices will prepare health systems for future crisis.


Subject(s)
Algorithms , Betacoronavirus , Coronavirus Infections/epidemiology , Disease Management , Pandemics , Pneumonia, Viral/epidemiology , Urologic Diseases/epidemiology , Urology/organization & administration , COVID-19 , Comorbidity , Hospitals/statistics & numerical data , Humans , SARS-CoV-2 , Surveys and Questionnaires , Urologic Diseases/therapy
12.
Scott Med J ; 65(4): 109-111, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-725597

ABSTRACT

BACKGROUND AND AIMS: Our departmental planning for COVID-19 was actioned a week before the lockdown (13th March 2020). We look at a 7- week lockdown activity for all scheduled outpatient clinics and urgent procedures. METHODS AND RESULTS: A total of 2361 outpatient clinic slots (52.6% oncology slots and 47.4% benign urology slots) were scheduled during this period. The oncology slots included 330 (26.5%) flexible cystoscopy, 555 (44.7%) prostate cancer and 357(28.8%) non-prostate cancer slots. The benign urology slots included 323 (28.8%) andrology, 193 (17.2%) stones and 603 (54%) lower urinary tract symptoms (LUTS) slots. Of the total oncology outpatient slots (n = 1242), 66.3% were virtual consultations, 20% were face-to-face and 13.6% were cancelled. Of the total benign outpatient slots (n = 1119), 81% were virtual consultations, 9.7% were face-to-face and 9.3% were cancelled. A total of 116 anaesthetic surgical procedures were carried out, of which 54 (46.5%) were oncological procedures, 18 (15.5%) were benign urological procedures, and 44 (38%) were diagnostic procedures. CONCLUSIONS: Hospitals and urologists can benefit from the model used by our hospital to mitigate the impact and prioritise patients most in need of urgent care. Reorganisation and flexibility of healthcare delivery is paramount in these troubled times and will allow clinical activity without compromising patient safety.


Subject(s)
Ambulatory Care/organization & administration , Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Telemedicine/organization & administration , Urology/organization & administration , COVID-19 , Communicable Disease Control/organization & administration , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Hospitals, University , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , SARS-CoV-2 , United Kingdom , Urologic Surgical Procedures , Urology Department, Hospital/organization & administration
13.
Urol J ; 17(5): 534-535, 2020 Jul 22.
Article in English | MEDLINE | ID: covidwho-680830

ABSTRACT

INTRODUCTION: On 11 March 2020, the World Health Organization (WHO) declared a pandemic. Since then hospitals have reduced inpatient and outpatient workflow and cancelled or suspended all non-emergent and routine surgical procedures. Our objective is to determine whether, during the COVID-19 period, there has been any modification in urological services. MATERIALS AND METHODS: We retrospectively studied the data from January-May 2020 and 2019 about the variables: number of operations, waiting list, visits in outpatient department, bladder instillations and urological emergencies and admission rates. RESULTS: Cancer cases high-risk for stage progression and surgical emergencies, were elected to proceed directly to treatment. The number of the operations was reduced by 43-65% from March-May 2020. Our surgical list had a waiting time of 6-8 weeks before the pandemic and now the waiting time has expanded to 12 weeks. Urological emergencies were reduced about 23-57%. Admission rates were dropped 10-51%. Visits in outpatient clinics were reduced 100-50% and outpatient procedures for elective cases were all deferred. Unfortunately, the hospital did not offer synchronous telehealth appointments. Bladder instillations of BCG or chemotherapeutics were not suspended but start of new cases had a delay of 2-3 weeks. There were no cases of COVID-19 in our department. CONCLUSION: All the variables of our urologic practice were affected during the COVID era. The impact of the reduced model of outpatient and inpatient workflow on the health of our patients is unknown. However, longer waiting lists are expected. It is obvious that healthcare providers should adopt a new healthcare model.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Pandemics , Pneumonia, Viral/epidemiology , Telemedicine/methods , Urologic Diseases/epidemiology , Urology/organization & administration , COVID-19 , Comorbidity , Coronavirus Infections/transmission , Humans , Pneumonia, Viral/transmission , Retrospective Studies , SARS-CoV-2 , Urologic Diseases/therapy
14.
Eur Urol ; 78(6): 812-819, 2020 12.
Article in English | MEDLINE | ID: covidwho-644256

ABSTRACT

CONTEXT: Telemedicine provides remote clinical support using technological tools. It may facilitate health care delivery while reducing unnecessary visits to the clinic. The coronavirus disease 2019 (COVID-19) outbreak has caused an abrupt change in our daily urological practice, converting many of us to be reliant on telehealth. OBJECTIVE: To provide practical recommendations for effective use of technological tools in telemedicine. EVIDENCE ACQUISITION: A Medline-based and gray literature search was conducted through April 2020. We selected the most relevant articles related to "telemedicine" and "smart working" that could provide important information. EVIDENCE SYNTHESIS: Telemedicine refers to the use of electronic information and telecommunications tools to provide remote clinical health care support. Smart working is a model of work that uses new or existing technologies to improve performance. Telemedicine is becoming a useful invaluable tool during and even beyond the COVID-19 pandemic. It is time for us to formalize the place of telemedicine in routine urological practice, and it is our responsibility to adapt and learn about all the tools and possible strategies for their optimal implementation during the pandemic to ensure that the quality of care received by patients and the outcomes of patients and their families are of the highest standard. CONCLUSIONS: Telemedicine facilitates specialized urological clinical support at a distance, solves problems of limitations in mobility, reduces unnecessary visits to clinics, and is useful for reducing the risk of viral transmission in the current COVID-19 outbreak. Furthermore, both personal and societal considerations may favor continued use of telemedicine, even beyond the COVID-19 pandemic. PATIENT SUMMARY: Telemedicine in urology offers specialized remote clinical support to patients, similar to face-to-face visits. It is very useful for reducing unnecessary visits to the clinic, as well as reducing the risk of contagion in the current coronavirus disease 2019 (COVID-19) pandemic.


Subject(s)
COVID-19 , Telemedicine , Urologic Diseases , Urology/organization & administration , Appointments and Schedules , COVID-19/prevention & control , Electronic Health Records , Humans , Interdisciplinary Communication , Privacy , SARS-CoV-2 , Telemedicine/economics , Telemedicine/methods , Triage , Urologic Diseases/diagnosis , Urologic Diseases/therapy , Urology/education , Urology/methods
15.
Int Braz J Urol ; 46(suppl.1): 170-180, 2020 07.
Article in English | MEDLINE | ID: covidwho-639402

ABSTRACT

PURPOSE: to provide an update on the management of a Urology Department during the COVID-19 outbreak, suggesting strategies to optimize assistance to the patients, to implement telemedicine and triage protocols, to define pathways for hospital access, to reduce risk of contagious inside the hospital and to determine the role of residents during the pandemic. MATERIALS AND METHODS: In May the 6th 2020 we performed a review of the literature through online search engines (PubMed, Web of Science and Science Direct). We looked at recommendations provided by the EAU and ERUS regarding the management of urological patients during the COVID-19 pandemic. The main aspects of interest were: the definition of deferrable and non-deferrable procedures, Personal Protective Equipment (PPE) and hospital protocols for health care providers, triage, hospitalization and surgery, post-operative care training and residents' activity. A narrative summary of guidelines and current literature for each point of interest was performed. CONCLUSION: In the actual Covid-19 scenario, while the number of positive patients globally keep on rising, it is fundamental to embrace a new way to deliver healthcare and to overcome challenges of physical distancing and self-isolation. The use of appropriate PPE, definite pathways to access the hospital, the implementation of telemedicine protocols can represent effective strategies to carry on delivering healthcare.


Subject(s)
Coronavirus Infections , Pandemics , Personal Protective Equipment , Pneumonia, Viral , Practice Guidelines as Topic , Urology/organization & administration , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Humans , Interprofessional Relations , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Telemedicine
17.
Eur Urol Focus ; 6(5): 1032-1048, 2020 Sep 15.
Article in English | MEDLINE | ID: covidwho-437422

ABSTRACT

CONTEXT: The unprecedented health care scenario caused by the coronavirus disease 2019 (COVID-19) pandemic has revolutionized urology practice worldwide. OBJECTIVE: To review the recommendations by the international and European national urological associations/societies (UASs) on prioritization strategies for both oncological and nononcological procedures released during the current emergency scenario. EVIDENCE ACQUISITION: Each UAS official website was searched between April 8 and 18, 2020, to retrieve any document, publication, or position paper on prioritization strategies regarding both diagnostic and therapeutic urological procedures, and any recommendations on the use of telemedicine and minimally invasive surgery. We collected detailed information on all urological procedures, stratified by disease, priority (higher vs lower), and patient setting (outpatient vs inpatient). Then, we critically discussed the implications of such recommendations for urology practice in both the forthcoming "adaptive" and the future "chronic" phase of the COVID-19 pandemic. EVIDENCE SYNTHESIS: Overall, we analyzed the recommendations from 13 UASs, of which four were international (American Urological Association, Confederation Americana de Urologia, European Association of Urology, and Urological Society of Australia and New Zealand) and nine national (from Belgium, France, Germany, Italy, Poland, Portugal, The Netherlands, and the UK). In the outpatient setting, the procedures that are likely to impact the future burden of urologists' workload most are prostate biopsies and elective procedures for benign conditions. In the inpatient setting, the most relevant contributors to this burden are represented by elective surgeries for lower-risk prostate and renal cancers, nonobstructing stone disease, and benign prostatic hyperplasia. Finally, some UASs recommended special precautions to perform minimally invasive surgery, while others outlined the potential role of telemedicine to optimize resources in the current and future scenarios. CONCLUSIONS: The expected changes will put significant strain on urological units worldwide regarding the overall workload of urologists, internal logistics, inflow of surgical patients, and waiting lists. In light of these predictions, urologists should strive to leverage this emergency period to reshape their role in the future. PATIENT SUMMARY: Overall, there was a large consensus among different urological associations/societies regarding the prioritization of most urological procedures, including those in the outpatient setting, urological emergencies, and many inpatient surgeries for both oncological and nononcological conditions. On the contrary, some differences were found regarding specific cancer surgeries (ie, radical cystectomy for higher-risk bladder cancer and nephrectomy for larger organ-confined renal masses), potentially due to different prioritization criteria and/or health care contexts. In the future, the outpatient procedures that are likely to impact the burden of urologists' workload most are prostate biopsies and elective procedures for benign conditions. In the inpatient setting, the most relevant contributors to this burden are represented by elective surgeries for lower-risk prostate and renal cancers, nonobstructing stone disease, and benign prostatic hyperplasia.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Urologic Neoplasms/diagnosis , Urologic Neoplasms/therapy , Urology/trends , Ambulatory Care/trends , Betacoronavirus , COVID-19 , Europe/epidemiology , Forecasting , Hospitalization/trends , Humans , Minimally Invasive Surgical Procedures/trends , Pandemics , SARS-CoV-2 , Societies, Medical , Telemedicine/trends , Urologic Diseases/diagnosis , Urologic Diseases/therapy , Urologic Surgical Procedures/trends , Urology/organization & administration , Urology/standards
18.
Actas Urol Esp (Engl Ed) ; 44(7): 450-457, 2020 Sep.
Article in Spanish | MEDLINE | ID: covidwho-427879

ABSTRACT

The COVID-19 pandemic caused by the SARS-CoV-2 virus has caused tens of thousands of deaths in Spain and has managed to breakdown the healthcare system hospitals in the Community of Madrid, largely due to its tendency to cause severe pneumonia, requiring ventilatory support. This fact has caused our center to collapse, with 130% of its beds occupied by COVID-19 patients, thus causing the absolute cessation of activity of the urology service, the practical disappearance of resident training programs, and the incorporation of a good part of the urology staff into the group of medical personnel attending these patients. In order to recover from this extraordinary level of suspended activity, we will be obliged to prioritize pathologies based on purely clinical criteria, for which tables including the relevance of each pathology within each area of urology are being proposed. Technology tools such as online training courses or surgical simulators may be convenient for the necessary reestablishment of resident education.


Subject(s)
Bed Occupancy/statistics & numerical data , Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Urology Department, Hospital/statistics & numerical data , Urology/statistics & numerical data , Ambulatory Care/statistics & numerical data , Bed Conversion/statistics & numerical data , COVID-19 , Coronavirus Infections/therapy , Humans , Internship and Residency , Pandemics , Patient Care Team/organization & administration , Patient Isolation , Pneumonia, Viral/therapy , SARS-CoV-2 , Spain/epidemiology , Urologic Surgical Procedures/statistics & numerical data , Urologists/supply & distribution , Urology/education , Urology/organization & administration , Urology Department, Hospital/organization & administration , Ventilators, Mechanical , Withholding Treatment/statistics & numerical data
20.
Prog Urol ; 30(8-9): 414-425, 2020.
Article in French | MEDLINE | ID: covidwho-304555

ABSTRACT

AIM: The management of urology patient is currently disrupted by the COVID-19 epidemic. In the field of functional urology, there are clinical situations with a high risk of complication if management is delayed and a great heterogeneity of advisable reprogramming times after cancellation. A prioritization of functional urology procedures is necessary to adapt management during the COVID-19 crisis and to better organize post-epidemic recovery. MATERIAL AND METHODS: The advice of AFU scientific committees in the field of functional urology (neuro-urology, female and perineology, male LUTS) was requested and supplemented by a review of the currently available recommendations on the subject of urology and COVID-19. These opinions were combined to draw up temporary recommendations to help reorganize practices during the epidemic and prepare the post-critical phase. RESULTS: Most of the recommendations available on career-oriented social networks (Twitter, LinkedIn) or in literature concern cancer or general urology. Eight out of ten propose a cancellation of all functional urology procedures without distinction. But the 3 AFU committees covering the field of functional urology have identified three clinical situations in which surgical procedures that can be maintained during the COVID-19 epidemic (priority level A): conclusion of a neuromodulation test in progress (implantation or explantation), botulinum toxin A bladder injections for unbalanced neurologic bladder, cystectomy and ileal conduit for urinary fistula in perineal bedsore or refractory unbalanced neurologic bladder with acute renal failure and vesico-enteric or prostato-pubic fistulas. Management adaptation of the other pathologies are proposed, as well as the application of 3 priority levels (B, C, D) for rescheduled procedures for a better management of the post-crisis activity resumption. CONCLUSION: The joint functional urology committees indicate that there are specific clinical situations in this field that demand non-delayed care during COVID crisis. They underline the need to establish a hierarchy for the cancelled surgeries, in order to reduce the arm of long reschedule delays and to optimize post-lockdown activity resumption.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Urologic Diseases/therapy , Urology/organization & administration , COVID-19 , Coronavirus Infections/prevention & control , Female , France/epidemiology , Humans , Male , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Urologic Surgical Procedures/methods
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